The Pharmaceutical Journal
Vol 272 No 7303 p731
12 June 2004

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Check epilepsy medication prescribed for newly diagnosed women

Pharmacists should check with a patient's GP if they are concerned about the epilepsy treatment prescribed for newly diagnosed women because of the increased risk of birth defects associated with some drugs, an epilepsy specialist has suggested.

Gus Baker, professor of clinical neuropsychology at the University of Liverpool, said: “If a pharmacist is concerned about the medication prescribed for a young woman of child-bearing age, they should think about contacting [the prescriber] about the potential teratogenic side effects, particularly if the prescriber is not an epilepsy specialist.”

Professor Baker was speaking after figures from the UK epilepsy and pregnancy register were revealed at the European Conference of Epileptology in Vienna last week. The results from 1996 to December 2003 found major congenital malformations in 4.3 per cent of 2,967 women taking any epilepsy treatment from a total of 3,545 reports. The rate was 6.0 per cent in the patients taking valproate, 4.2 per cent in women taking phenytoin, 2.9 per cent for women taking lamotrigine, 2.3 per cent for those on carbamazepine, and 2.9 per cent for women diagnosed with epilepsy who were not taking any epilepsy therapy. When women were treated with valproate plus another epilepsy drug, the level of major birth defects reached 10.8 per cent.

James Morrow, clinical director of neurology at the Royal Victoria Hospital, Belfast, said the results were reassuring. “Overall, 95 per cent of pregnancies in women with epilepsy do not result in major malformations. But the rate for valproate is higher, and it appears to be especially high when used in combination.” He added that valproate remains the drug of choice for many people with epilepsy. “However, a woman being treated with valproate, or potentially being treated, needs to be aware of the risks so they can make an informed choice.”

National Institute for Clinical Excellence guidance suggests that newer anti-epilepsy drugs should be used when older drugs, such as carbamazepine and sodium valproate, are unsuitable. The guidance also stresses the importance of pre-conception counselling (PJ, 27 March, p371).